Patients with COPD may benefit from nocturnal oxygen therapy during high-altitude travel
Click Here to Manage Email Alerts
Patients with moderate to severe COPD traveling to high altitude experienced improvements in hypoxemia, breathing disturbances and other adverse health effects with nocturnal oxygen therapy, according to data published in JAMA Network Open.
“Patients with moderate to severe COPD who are traveling to moderately high altitude may experience nocturnal hypoxemia, sleep apnea and other adverse health effects,” Michael Furian, PhD, senior researcher at the pulmonary division at the University Hospital Zurich, told Healio. “In the current randomized trial, nocturnal oxygen therapy improved oxygenation, sleep-related breathing disturbances and prevented adverse health effects.”
Researchers enrolled 32 patients (mean age, 65.6 years; 53% women) with moderate to severe COPD who were lowlanders living below 800 m. Patients enrolled had FEV1 between 30% and 80% predicted, pulse oximetry of at least 92%, no oxygen therapy requirement and no history of sleep apnea. The researchers performed baseline assessments at the University Hospital Zurich, which is located at 490 m altitude, and then during two stays (2 days, 2 nights) at a Swiss Alpine hotel, located at 2,048 m altitude, after patients were randomly assigned to nocturnal oxygen therapy (3 L/min) or placebo. Between the two evaluations, patients were required to spend at least 2 weeks at low altitude.
The coprimary outcomes were difference in mean nocturnal oxygen saturation measured by pulse oximetry and apnea-hypopnea index (AHI) measured by polysomnography on the first night at high altitude.
Mean nocturnal oxygen saturation was significantly decreased during both stays at 2,048 m with placebo (night 1: 86%; night 2: 87%) compared with the baseline assessment at 490 m (92%; P < .001), and mean total AHI was significantly increased with placebo (night 1: 34.9/h; night 2: 27.8/h) compared with the baseline assessment at 490 m (21.6/h; P < .001).
Nocturnal oxygen therapy increased nocturnal oxygen saturation by a mean of 9 percentage points (95% CI, 8-11; P <.001), decreased AHI by 19.7/h (95% CI, 11.4-27.9; P < .001) and improved sleep quality, as measured on a visual analog scale, by 9 percentage points (95% CI, 0-17; P = .04), according to the results.
Overall, eight (26%) patients treated with placebo and one (4%) patient treated with nocturnal oxygen therapy experienced altitude-related adverse health effects at 2,048 m or within 24 hours of descent (P < .001).
“Our study provides good news for many patients with COPD who enjoy mountain travel, as they can now rely for the first time on an evidence-based measure to support their well-being while staying at high altitude,” Furian told Healio.
According to Furian, these findings are clinically important as they may change clinical practice of counseling and treating patients with COPD traveling to high altitude areas.
“Nocturnal oxygen therapy improved nocturnal sleep-disturbed breathing and reduced the incidence of adverse events; however, which COPD patients are at increased risk for altitude maladaptation and which would benefit most from nocturnal oxygen therapy remains to be elucidated,” Furian said. “Therefore, a clinical trial in COPD investigating risk factors and predictors during pre-ascent assessments would further improve clinical practice and counseling of COPD patients planning an altitude sojourn.”